The unique cognitive phenotype of ASD + ADHD co-occurrence: evidence for planning and attention deficits as a differentiating approach

TL;DR

This study shows that children with both autism and ADHD have unique cognitive challenges in planning and attention, which can help in their diagnosis.

Contribution

The study identifies planning and attention deficits as key markers for differentiating ASD + ADHD from ASD-alone and ADHD-alone.

Findings

ASD + ADHD children scored lower on all four cognitive processes compared to other groups.

Planning and attention had high diagnostic accuracy for identifying ASD + ADHD among children with ASD.

Inattention symptoms were linked to lower planning and attention scores.

Abstract

This study aimed to assess cognitive processing in children with autism spectrum disorder (ASD) without co-occurring attention-deficit/hyperactivity disorder (ADHD) (ASD-alone), children with ADHD without co-occurring ASD (ADHD-alone), and children with ASD with co-occurring ADHD (ASD + ADHD).

Children were divided into four groups: ASD-alone (n = 57), ADHD-alone (n = 89), ASD + ADHD (n = 56), and typical development (TD) (n = 58). The Das–Naglieri Cognitive Assessment System (D-N CAS) was applied to evaluate planning, attention, simultaneous, and successive cognitive processes.

Children with ASD-alone scored less on planning processing. Children with ADHD-alone scored lower on planning and attention processing. Children with ASD + ADHD scored lower on all four processes. Planning and attention exhibited satisfactory stratification precision in identifying ASD + ADHD among children with ASD, with area under the curve (AUC) values of 0.7426 and 0.8061, respectively. Successive processing had medium diagnostic value in diagnosing ASD + ADHD among children with ADHD, with an AUC of 0.618. Inattention symptoms were associated with planning and attention processing. Social affects and inattention symptoms were associated with the total D-N CAS score.

Children with ASD-alone, ADHD-alone, and ASD + ADHD exhibited distinct cognitive profiles. The D-N CAS, particularly its planning and attention scales, provided an approach for differential diagnosis in clinical settings.

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